Author Discussion Series- Thomas R. de Wijkerslooth

An original article from the Clinical Endoscopy section of the April issue: “Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time” by Thomas R. de Wijkerslooth, MD, Esther M. Stoop, MD, Patrick M. Bossuyt, PhD, Kristien M.A.J. Tytgat, MD, PhD, Jan Dees, MD, Elisabeth M.H. Mathus-Vliegen, MD, PhD, Ernst J. Kuipers, MD, PhD, Paul Fockens, MD, PhD, Monique E. van Leerdam, MD, PhD, Evelien Dekker, MD, PhD

Thomas R. de Wijkerslooth from the Academic Medical Center at the University of Amsterdam, shares some insights about his article “Differences in proximal serrated polyp detection among endoscopists are associated with variability in withdrawal time.” 

We wanted to identify patient and endoscopist-related factors associated with proximal serrated polyp detection. The role of serrated polyp detection may have been underestimated in recent years. Serrated polyps may develop into cancer via “the serrated pathway.” Definitive evidence for this pathway is still lacking. Serrated polyp detection in the proximal colon is associated with synchronous advanced neoplasia. Further, the authors from the National Polyp Study showed that among 2,600 patients who had adenomas removed and had received adenoma surveillance, 12 patients still died from CRC. Possibly, it may be hypothesized that these interval CRCs were the result of “the serrated pathway.” Serrated polyp detection seems to be more important and our study contributes to the detection of these polyps.

We presented that proximal serrated polyp (PSP) detection differed between endoscopists. Further, longer withdrawal time was significantly associated with better PSP detection while patient age, gender, and quality of the bowel prep were not (Table 2). The latter is surprising. We hypothesized that the mucus cap on the serrated polyp attaches residual stool, attracting attention and highlighting the polyp, especially if the proximal colon is rinsed with water. We conclude that PSP detection depends on the skills of the endoscopist, such as withdrawal time.

Read the abstract of the article here.


The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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